Is vomiting a sign of a stroke
Searched over 200M research papers
Summary
10 papers analyzed
These studies suggest that vomiting can be an early sign of a stroke, particularly in ischemic brainstem strokes and severe cases with high NIHSS scores.
Consensus Meter
5 papers analyzed
Yes - 80%
Possibly - 20%
No - 0%
Research summarized with Copilot
Beta20 papers analyzed
Vomiting as a Sign of Stroke: Insights from Recent Research
Vomiting and Stroke Types
Vomiting is a common symptom observed in stroke patients, but its prevalence varies significantly across different types of strokes. A study examining stroke patients in the Kyoto prefecture found that vomiting occurred in 14.5% of all stroke cases. When broken down by stroke type, vomiting was present in 8.7% of cerebral infarction (CI) cases, 23.7% of cerebral hemorrhage (CH) cases, and 36.8% of subarachnoid hemorrhage (SAH) cases. This indicates that vomiting is more frequently associated with hemorrhagic strokes compared to ischemic strokes.
Vomiting as a Predictor of Stroke Outcome
Vomiting at the onset of a stroke has been linked to a higher risk of mortality. The same study from Kyoto reported that patients who experienced vomiting had a significantly higher hazard ratio (HR) for death compared to those who did not. Specifically, the HR for death was 5.06 for all stroke patients, 5.27 for CI, 2.82 for CH, and 5.07 for SAH. This suggests that vomiting can be an early predictor of poor outcomes in stroke patients.
Vomiting in Ischemic Brainstem Strokes
In cases of ischemic brainstem strokes, vomiting can be a prominent symptom even when other neurological signs are minimal or absent. This can lead to misdiagnosis as a gastrointestinal disorder rather than a stroke. For instance, a case study highlighted a patient who experienced severe vomiting without dizziness, headache, or abdominal pain, which was later identified as an ischemic brainstem stroke. This underscores the importance of considering stroke in the differential diagnosis when patients present with unexplained vomiting.
Nausea and Vomiting as Indicators of Fatal Brain Edema
Nausea and vomiting within 24 hours of stroke onset have been identified as independent predictors of fatal brain swelling. A study analyzing patients with large middle cerebral artery (MCA) strokes found that early nausea/vomiting significantly increased the odds of developing fatal brain edema . This finding is crucial for early identification and intervention in high-risk stroke patients.
Misdiagnosis and Atypical Stroke Symptoms
Symptoms like nausea and vomiting can lead to the misdiagnosis of stroke, particularly in cases involving the posterior circulation. A study revealed that strokes presenting with atypical symptoms such as nausea/vomiting and dizziness were more likely to be missed in the emergency department. This was especially true for posterior strokes, which were misdiagnosed 37% of the time compared to 16% for anterior strokes. Improving diagnostic accuracy for these atypical presentations is essential for timely and effective stroke management.
Conclusion
Vomiting is a significant symptom in stroke patients, particularly in hemorrhagic strokes and ischemic brainstem strokes. It serves as an important predictor of stroke outcomes, including mortality and the risk of fatal brain edema. However, the presence of vomiting can also complicate diagnosis, leading to potential misdiagnosis as gastrointestinal issues. Recognizing vomiting as a potential sign of stroke and understanding its implications can improve early diagnosis and intervention, ultimately enhancing patient outcomes.
Sources and full results
Most relevant research papers on this topic
